Provider Demographics
NPI:1881960912
Name:IVYMOUNT OUTREACH PROGRAMS, INC
Entity type:Organization
Organization Name:IVYMOUNT OUTREACH PROGRAMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE/ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LEE-NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-469-0223
Mailing Address - Street 1:11614 SEVEN LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3261
Mailing Address - Country:US
Mailing Address - Phone:301-469-0223
Mailing Address - Fax:301-469-0778
Practice Address - Street 1:11614 SEVEN LOCKS RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3261
Practice Address - Country:US
Practice Address - Phone:301-469-0223
Practice Address - Fax:301-469-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health